Name *

First Name

Last Name

Are there pronunciation instructions you'd like to include so we can do our best to honor your name?

First Name

Last Name

Phone Number *

(###)

###

####

May we leave a voicemail or send a text? *

Yes, both

Voicemail preferred

Text message preferred

Neither

What services are you seeking? *

Please check all that may apply

Individual pre-teen counseling

Individual teen counseling

Young adult counseling

Family therapy

Parent coaching

Other

What time frames are you needing for appointments? *

Select all that apply

weekday mornings

weekday afternoons

weekday evenings

weekends

Where are you in your search for a therapist? *

just started shopping around

looking around, no rush to get started

ready to book a consultation

need support, like yesterday

How often might you want to have sessions? *

(it's totally okay to not know!)

weekly

every other week

unsure

other

Are you wanting in-person sessions or virtual? *

Note: all sessions with Meredith are held virtually!

virtual

I am aware that ATT does not accept insurance *

Yes